Evaluating the Relationship between the Driver and Roadway to Address Rural Intersection Safety using the SHRP 2 Naturalistic Driving Study Data, RB05-013, 2016

Rural intersections account for 30% of crashes in rural areas and 6% of all fatal crashes, representing a significant but poorly understood safety problem. Transportation agencies have traditionally implemented countermeasures to address rural intersection crashes but frequently do not understand the dynamic interaction between the driver and roadway and the driver factors leading to these types of crashes. The Second Strategic Highway Research Program (SHRP 2) conducted a large-scale naturalistic driving study (NDS) using instrumented vehicles. The study has provided a significant amount of on-road driving data for a range of drivers. The present study utilizes the SHRP 2 NDS data as well as SHRP 2 Roadway Information Database (RID) data to observe driver behavior at rural intersections first hand using video, vehicle kinematics, and roadway data to determine how roadway, driver, environmental, and vehicle factors interact to affect driver safety at rural intersections. A model of driver braking behavior was developed using a dataset of vehicle activity traces for several rural stop-controlled intersections. The model was developed using the point at which a driver reacts to the upcoming intersection by initiating braking as its dependent variable, with the driver’s age, type and direction of turning movement, and countermeasure presence as independent variables. Countermeasures such as on-pavement signing and overhead flashing beacons were found to increase the braking point distance, a finding that provides insight into the countermeasures’ effect on safety at rural intersections. The results of this model can lead to better roadway design, more informed selection of traffic control and countermeasures, and targeted information that can inform policy decisions. Additionally, a model of gap acceptance was attempted but was ultimately not developed due to the small size of the dataset. However, a protocol for data reduction for a gap acceptance model was determined. This protocol can be utilized in future studies to develop a gap acceptance model that would provide additional insight into the roadway, vehicle, environmental, and driver factors that play a role in whether a driver accepts or rejects a gap.

Nou edifici de la Policia Portuària, Arxiu i Departament de Conservació al Port de Barcelona

Award-winning

Iowa Rural and Agricultural Health and Safety Resource Plan, 2011

The Iowa Department of Public Health (IDPH) convened the Health and Long-Term Care Advisory Council (HLTCAC) to assist in the development of its strategic plan. One component of the strategic plan is a rural health care resource plan. The intent of this document is to present reliable information and data as a valuable resource for the officials, agencies, and organizations responsible for strengthening and supporting the rural health systems vital to 43 percent of Iowa residents.

Farm Safety is Important in Iowa, October 11, 2012

An IDPH Occupational Health and Safety Surveillance Program (OHSSP) analysis of Iowa’s work-related traumatic fatalities shows that transportation events accounted for 48 of 90 deaths in 2011. Agricultural activities were involved in 21 of the 48 transportation deaths (44%) and 32 of the 90 total fatalities (36%). Tractor and ATV (all-terrain vehicle) or UTV (utility vehicle) rollovers were responsible for 62% (13/21) of the farm or ag-related transportation deaths.

Surgical safety and hospital volume across a wide range of interventions

OBJECTIVES:: For certain major operations, inpatient mortality risk is lower in high-volume hospitals than those in low-volume hospitals. Extending the analysis to a broader range of interventions and outcomes is necessary before adopting policies based on minimum volume thresholds. METHODS:: Using the United States 2004 Nationwide Inpatient Sample, we assessed the effect of intervention-specific and overall hospital volume on surgical complications, potentially avoidable reoperations, and deaths across 1.4 million interventions in 353 hospitals. Outcome variations across hospitals were analyzed through a 3-level hierarchical logistic regression model (patients, surgical interventions, and hospitals), which took into account interventions on multiple organs, 144 intervention categories, and structural hospital characteristics. Discriminative performance and calibration were good. RESULTS:: Hospitals with more experience in a given intervention had similar reoperation rates but lower mortality and complication rates: odds ratio per volume deciles 0.93 and 0.97. However, the benefit was limited to heart surgery and a small number of other operations. Risks were higher for hospitals that performed more interventions overall: odds ratio per 1000 for each event was approximately 1.02. Even after adjustment for specific volume, mortality varied substantially across both high- and low-volume hospitals. CONCLUSION:: Although the link between specific volume and certain inpatient outcomes suggests that specialization might help improve surgical safety, the variable magnitude of this link and the heterogeneity of hospital effect do not support the systematic use of volume-based referrals. It may be more efficient to monitor risk-adjusted postoperative outcomes and to investigate facilities with worse than expected outcomes.

Grammaire générale et raisonnée de Port-Royal , par Arnauld et Lancelot, précédée d'un Essai sur l'origine et les progrès de la langue françoise, par M. Petitot, et suivie du commentaire de M. Duclos

Comprend : Essai sur l'origine et les progrès de la langue françoise

Safety concerns about CCR5 as an antiviral target.

PURPOSE OF REVIEW: Clinical trials of CCR5 antagonists attest to their efficacy and tolerance in HIV treatment. However, there has been debate on their long-term safety because of the role of CCR5 in innate immunity. This review highlights gaps in our understanding of epidemiology of infections that are modulated by CCR5, in particular, in HIV-infected individuals. RECENT FINDINGS: In the mouse model, CCR5 has a role in the response against pathogens as diverse as Toxoplama gondii, West Nile virus, Mycobacterium tuberculosis, herpes simplex virus, Trypanosoma cruzi, Cryptococcus neoformans, Chlamydia trachomatis, Listeria, and plasmodia. In human cohorts, individuals carrying the defective CCR5Delta32 allele present an increased susceptibility to flavivirus (West Nile virus and tickborne encephalitis virus). The selective pressures that led to the spread of loss-of-function CCR5 mutations in humans (CCR5Delta32), and in mangabeys (CCR5Delta24) are not understood. SUMMARY: The recent availability of CCR5 antagonists has raised concern that genetic, biological, or chemical CCR5 knockout, although beneficial against some pathogens (i.e. HIV), could be deleterious for other processes implicated in pathogen response. The consequences of long-term pharmaceutical intervention on CCR5 should be carefully assessed through rigorous postmarketing surveillance.

Safety of a new algorithm for the management of childhood illness (Almanach) to improve quality of care and rational use of drugs

Introduction New evidence from randomized controlled and etiology of fever studies, the availability of reliable RDT for malaria, and novel technologies call for revision of the IMCI strategy. We developed a new algorithm based on (i) a systematic review of published studies assessing the safety and appropriateness of RDT and antibiotic prescription, (ii) results from a clinical and microbiological investigation of febrile children aged <5 years, (iii) international expert IMCI opinions. The aim of this study was to assess the safety of the new algorithm among patients in urban and rural areas of Tanzania.Materials and Methods The design was a controlled noninferiority study. Enrolled children aged 2-59 months with any illness were managed either by a study clinician using the new Almanach algorithm (two intervention health facilities), or clinicians using standard practice, including RDT (two control HF). At day 7 and day 14, all patients were reassessed. Patients who were ill in between or not cured at day 14 were followed until recovery or death. Primary outcome was rate of complications, secondary outcome rate of antibiotic prescriptions.Results 1062 children were recruited. Main diagnoses were URTI 26%, pneumonia 19% and gastroenteritis (9.4%). 98% (531/541) were cured at D14 in the Almanach arm and 99.6% (519/521) in controls. Rate of secondary hospitalization was 0.2% in each. One death occurred in controls. None of the complications was due to withdrawal of antibiotics or antimalarials at day 0. Rate of antibiotic use was 19% in the Almanach arm and 84% in controls.Conclusion Evidence suggests that the new algorithm, primarily aimed at the rational use of drugs, is as safe as standard practice and leads to a drastic reduction of antibiotic use. The Almanach is currently being tested for clinician adherence to proposed procedures when used on paper or a mobile phone

Social Media in health. What are the safety concerns for healthcare consumers?

Recent literature has discussed the unintended consequences of clinical information technologies (IT) on patient safety, yet there has been little discussion about the safety concerns in the area of consumer health IT. This paper presents a range of safety concerns for consumers in social media, with a case study on YouTube. We conducted a scan of abstracts on 'quality criteria' related to YouTube. Five areas regarding the safety of YouTube for consumers were identifi ed: (a) harmful health material targeted at consumers (such as inappropriate marketing of tobaccoor direct-to-consumer drug advertising); (b) public display of unhealthy behaviour (such as people displaying self-injury behaviours or hurting others); (c) tainted public health messages (i.e. the rise of negative voices againstpublic health messages); (d) psychological impact from accessing inappropriate, offensive or biased social media content; and (e) using social media to distort policy and research funding agendas. The examples presented should contribute to a better understanding about how to promote a safe consumption and production of social media for consumers, and an evidence-based approach to designing social media interventions for health. The potential harm associated with the use of unsafe social media content on the Internet is a major concern. More empirical and theoretical studies are needed to examine how social media infl uences consumer health decisions, behaviours and outcomes, and devise ways to deter the dissemination of harmful infl uences in social media.

Armes et munitions. Fabrication, commerce, acquisition, détention et port . Edition mise à jour au 3 novembre 1956

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